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J Behav Addict. 2016 Sep;5(3):429-38. doi: 10.1556/2006.5.2016.045. Epub 2016 Jul 21.

Relationships Between Problem-Gambling Severity and Psychopathology as Moderated by Income.

Author information

1 Yale Child Study Center, Yale University School of Medicine , New Haven, CT, USA.
2 University of Connecticut , Storrs, CT, USA.
3 Department of Veterans Affairs, VISN 1 Mental Illness Research Education and Clinical Center , West Haven, CT, USA.
4 Department of Psychiatry, Yale University School of Medicine , New Haven, CT, USA.
5 Department of Biostatistics, Yale School of Public Health , New Haven, CT, USA.
6 Department of Neuroscience and the National Center on Addiction and Substance Abuse (CASAColumbia), Yale University School of Medicine , New Haven, CT, USA.
7 Connecticut Mental Health Center, Yale University School of Medicine , New Haven, CT, USA.


Background and aims Problem and pathological gambling have been associated with elevated rates of both Axis-I and Axis-II psychiatric disorders. Although both problem gambling and psychiatric disorders have been reported as being more prevalent among lower income vs. middle/higher income groups, how income might moderate the relationship between problem-gambling severity and psychopathology is incompletely understood. To examine the associations between problem-gambling severity and psychopathology in lower income and middle/higher income groups. Methods Data from the first wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (n = 43,093) were analyzed in adjusted logistic regression models to investigate the relationships between problem-gambling severity and psychiatric disorders within and across income groups. Results Greater problem-gambling severity was associated with increased odds of multiple psychiatric disorders for both lower income and middle/higher income groups. Income moderated the association between problem/pathological gambling and alcohol abuse/dependence, with a stronger association seen among middle/higher income respondents than among lower income respondents. Discussion and conclusions The findings that problem-gambling severity is related to psychopathology across income groups suggest a need for public health initiatives across social strata to reduce the impact that problem/pathological gambling may have in relation to psychopathology. Middle/higher income populations, perhaps owing to the availability of more "disposable income," may be at greater risk for co-occurring gambling and alcohol-use psychopathology and may benefit preferentially from interventions targeting both gambling and alcohol use.


NESARC; income; problem gambling; psychiatric disorders; psychopathology

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